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SEPTEMBER 1, 2009 3:17PM

Huffington Post Health Watch: OrnishCare

Rate: 13 Flag
The Huffington Post



It looks like the Huffington Post's honorary/unpaid Medical Editor, Dr.Dean Ornish, walked into the same trap that Whole Foods CEO John Mackey did.

 Mackey got a lot of flack when he wrote an oped in the Wall Street Journal on health care reform, one in which he emphasized the need for personal responsibility for our health.  

 Ornish, in an effort to inject himself into the current debate, blogged "Don't Tread on Me:  Transcending the Left Wing/Right Wing Health Care Debate." 

On the surface, the piece is quite reasonable--Ornish discusses his 14-year fight to get Medicare to pay for services that rewarded doctors for helping to prevent disease. But in doing so:

 "I understand those who think that single-payer health care is the way to go. However, after needing 14 years to get Medicare to do something as obvious as paying for intensive lifestyle changes scientifically proven to reverse heart disease despite the strong personal support of those at the highest levels of government and the leading experts in the scientific community, I share the Republican concern about greatly expanding the power of the Centers for Medicare and Medicaid Services. I'm as deeply suspicious of big government as anyone. I'm strongly in favor of universal coverage but not single payer."

Ornish goes onto tell us how he is equally suspicious of insurance companies.  Then he proposes OrnishCare:

"There is a third alternative. The idea that changing our lifestyle can prevent and even reverse the most common, the most deadly, and most expensive diseases transcends the old left wing/right wing, red state/blue state divisions. These are profoundly human issues that we can all support, bringing together liberals and conservatives, labor and management."

 OrnishCare must have reminded the HuffPo audience of MackeyCare, as he received a plethora of comments criticizing him as naive and elitist.

"Foolish academic BS from someone who has never been without access to healthcare," wrote one reader.

From another:  "The problem with your third line of reasoning-­-reasonabl­e as it is--was demonstrated to me today at Church where our wonderful Knights of Columbus put on a glorious gut-busting breakfast including eggs, ham, sausage, bacon, HFCS-loaded syrups, fruit treats, doughnuts, omelets, cheesey-potatoes, French toast, and pancakes, topped off with a celebration chocolate cake for the new pastor. This after a service listing all the folks in the parish being treated for cancer and heart disease"

These same kind of class-war comments led Whole Foods customers to boycott the store because of MackeyCare.

Probably the most insightful comments came from health care and economics writer Merrill Goozner.  He wrote about Ornish's piece on The Health Care Blog:

"I spent much of last year trying to shoehorn the Ornish philosophy into the health care debate. I agree we need to pay for cost-effective prevention options -- including the Ornish approach to lifestyle intervention for people seriously at risk of heart disease.

But it's a tough fit because that's not going to end disease in America. And as long as people continue to get sick, they will face the problem of an inadequate insurance system and an out-of-control medical system. As one intelligent commentator pointed out, every one of us is eventually going to get sick, face a traumatic injury or an unexplained illness. Every one is going to die, and many will face agonizing end-of-life medical choices -- no matter how healthful their lifestyles.

When any of that happens, they deserve a well-functioning and reasonably priced sick care system. The last thing a sick person needs is a lecture on how they ate wrong and failed to get enough exercise in the months and years leading up to the acute event."

 I couldn't have said it better myself.  And, like Goozner said, eventually you, me, and Dean Ornish are going to need that well-functioning and reasonably priced sick care system. 





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And once again, the weekly spot for promoting OPEN Salon writing goes to... a Salon staff writer!

No offense, Dr. Parikh. You're an excellent writer and I enjoy your stuff, which illuminates health issues for laymen. I simply think this belongs on Salon proper (aka "the mothership") whereas this once weekly spot for stuff from OPEN Salon should go to someone who has yet to snag a regular (paying, I dare guess) gig with a large site. It's simply not what the Open Salon rubric on Tuesdays on the mothership was meant to accomplish, to my limited understanding. I thought it was supposed to be a means of exposing the wonderful writing of people who don't get published regularly on Salon. People like you already get published on Salon. Are Joan and Kerry saying there is not a single worthy article from the past 48-72 hours on Open Salon that's still relevant and good enough to get the exposure?

And as I did when addressing the same comment to one of my absolute favorite writers, King Kaufman (that was last week's filling the blue spot with a red writer), a disclaimer: although I did write something this week, it was run of the mill for my stuff and NOT deserving of the exposure this week. I'm not whining for me, but really for the principle. The blue item on Salon.com on Tuesdays should go only to people who don't have a regular gig writing (or editing on a break from writing) with Salon itself or another comparable-size site. It's like a top-40 act winning a talent search. It's petty and self-destructive. It does nothing to expose the actual unique content of Open Salon.

If Kerry and Joan really think that the "regular" writers of Open Salon so rarely produce stuff that merits Mothership exposure, perhaps they should be honest about it and give pointers on how to qualify.

Rated, btw. A fine article, all of the above kvetching notwithstanding.
Very good. The Goozner stuff is right on the money, too.
BTW, this notion that if we all eat healthy, get exercise and count to ten every time someone's being a motherfucking idiot within earshot that'll solve the problem and people won't get ruined by health care costs - that IS elitist bullcrap. I would've said something about HuffPo's general limousine liberal ambiance, but I decided to count to ten... Nope, still sniffling.
I don't think anyone is saying (at least that's not how I read the piece) that what docs call TLC or Therapeutic Lifestyle Change will SOLVE all our healthcare problems. Of course it won't. People will still get cancer for genetic and environmental reasons, still develop neurological diseases, still be hit by cars and inhale toxic fumes at unsafe workplaces. Fair enough. But lifestyle change and Americans will improve things, won't it? It's irresponsible to claim otherwise.

The bitching about "elitism" sounds to me more like folks expecting Big Guvmint to take care of their health when, let's face it, responsibility for our wellness begins with each of us. Look at the statistics: cardiovascular disease, Type II diabetes, many cancers, stroke, arthritis—they are all overwhelmingly diseases of lifestyle that are far more likely to strike people who are obese, inactive, stressed-out and who eat garbage diets. It is not elitist to suggest that American healthcare would be in far better shape if Americans were in far better shape. Walking a few miles a day, planting some tomatoes, herbs and other healthy foods in a terrace garden, learning to meditate to manage stress, drinking more water and less sugary soda...these cost next to nothing.

No, prevention won't make disease go away. But I'm reminded of Bill Bryson lamenting how the Park Service was letting great chestnut trees in the Appalachians die because they didn't have the budget to treat them all: "How about treating SOME?" Wouldn't Americans making even moderate lifestyle changes to prevent millions of heart attacks, help seniors need less medication and less costly care and taking some pressure off our system be a good thing? No, it won't prevent people from getting sick and dying, but I for one would rather take control of my own health and live long and well and need the healthcare system as little as possible than throw up my hands and cry, "Elitist pigs! Now give me my government-sponsored Lipitor!"
You *really* missed the boat on this one, Dr. P.

Yes, of course we're all going to need that sick-care system in the end, but helping people forestall all of those lifestyle-mediated chronic diseases should be a core part of healthcare reform. Yes, as it stands, the only people that can afford the time and money for real preventative care are more affluent than the rest of the nation. That doesn't make support for these ideas classist or elitist; it just means that we've got an entire social, economic, and medical system so warped that large portions of the population are so overworked and exhausted that at the end of their workday they've only got the energy to veg out with KFC and "American Idol," and they've often learned to only go to the doctor when something is wrong.

Yes, when anybody has an MI, get them to a cath lab and offer them great rehab - and everything from the ambulance ride to the cab home should be covered. But maybe, just maybe, we should also consider paying physicians and other healthcare providers reasonable rates for spending the NECESSARY time with patients to help support lifestyle changes.

This shouldn't be an either/or proposition. It needs to be a both/and.
How about we incorporate healthy choices and lifestyles in public school?! We obviously cannot count on parents, god forbid, to teach their children these vital things to ensure they will grow up knowing how to be healthy individuals, short of catastrophic desease, life altering accidents and inherited health issues. School would be a very wise place to teach our young how to make healthy choices, both in diet and exercise. There is nothing elitist about good quality education in public education last time I checked. Parents do need to step up on this important education at home as well.

Very good post and healthy food for thought!
Schools?????? Please!! They barely educate our children now.
"but helping people forestall all of those lifestyle-mediated chronic diseases should be a core part of healthcare reform."

How core can it be? You have X dollars. Beyond a certain sum, every dollar spent on haranguing people to eat healthy and exercise, and coming up with PR on how to get them on board, means one less dollar for someone who's sick RIGHT NOW.

Notice that healthy living, end of life and all that counseling stuff is already part of the proposals making the rounds. You think the number should be upped a little? Fine. That's a tactical detail, not a strategy thing. Right now people don't get the simple medication they need. That's more important than some top-down telling people how to live. In countries like ours, lifestyle changes don't happen because government said you should. Government can help, but the real change comes from the ground up. Just like the advent of counter-culture, homeschooling, organic food and alla that.

The big picture in health care is doctors, drugs and hospital beds. The Japanese live much healthier lifestyles than us by most parameters. They still need them.
In his WSJ OpEd Whole Foods CEO John Mackey argues that poor "lifestyle choices" -- mainly diet/obesity and lack of exercise -- account for 70% os U.S. health care costs (where he gets "70%" I have no idea, he doesn't cite any data sources). I saw that assertion and then went at looked at WHO data for the European nations last night. Guess what? Similar prevalence of these same suboptimal "lifestyle" conditions, yet they STILL somehow manage to significantly outperform us on a broad array of health metrics -- at roughly HALF our per capita spending.

Mr. Mackey should stick to running his business, and leave public health epidemiology and health care economics to those with the requisite expertise.
True, everyone will need a "reasonably priced sick care system." at some point. Nicely said.

I'm surprised that though that "readers" got a chance to express their opposing viewpoints at Huffington Post. Who did they have to pay off, I wonder?
If we weren't subsidizing poor health choices like foods with HFCS and chemical additives while not helping out local growers of high quality produce and meats, I might agree with Ornish. If we want to go that route then let's start with the farm bill. Make healthy food cheaper and junk food cost what it should and then we can start talkng about lifestyle "choices".
Thank you so much for this. You make some excellent points. I would like to add that there are toxins in our environment that I do not hear all of these "it's the individual's responsibility to maintain their own health" mouthpieces addressing. It's like asking the individual to end global warming by switching lightbulbs.
I would like to add that while poor eating choices and inactivity do lead to obesity and sometimes type 2 diabetes, people who drink alcohol moderately to excessively who are not obese are also at a higher risk for type 2 diabetes and other health issues.
Glad Ornish got flack for that. He deserves every bit of it. When the U.S. actually lowers its mortality and obesity rate to something close to Canada's, then they can whine about "dangers" of big government.

I believe strongly in the importance of preventative health care, but detest lifestyle activists who think this is a substitute for non discriminatory health care policy .

And doctors getting paid extra for preventative health care?!! Move to China. Maybe Ornish can revive the practice of paying doctors to keep you healthy and not being obligated to pay if you get sick.

As a Canuck, I wonder if Ornish might not have a ( poorly expressed) point. It seems rather obvious to me that preventative care by doctors, which might include lifestyle pointers, will save money and reduce ER wait times.

I've got a long history of high blood pressure in the family, and I'm closely monitored for it. About six months ago, my GP gave me a choice- I can either go on BP meds or get it under control myself via diet and exercise, and she gave me some advice in that area. It turned out to be exactly the kick in the butt I needed.
As a taxpayer, I am already subsidizing the health care of MOST of the people in this country, through Medicare, Medicaid, Veterans, S-CHIP, and the tax deduction for employer-based health insurance. I take excellent care of my body, yet I know I am one accident or serious illness away from bankruptcy and permanent unemployability.

I support single-payer on purely pragmatic grounds. We're already paying enough taxes for it. 58% of health care costs in this country are born directly by the taxpayer. On a per capital basis, that's more than TOTAL spending on health care in all but three other countries. In plain language, we're paying more in taxes than Canadians do. Why can't we have the same kind of health care Canadians do?

Having said that, people need to realize we don't have an infinite amount of money to spend of medical interventions. I think it is ridiculous that people expect the government to pay for recreational drugs like Viagra, or treatments with marginal effects (like cholesterol-lowering drugs), or treatments that have not been shown to produce clinically significant benefits (like colonoscopy), or which HAVE been shown NOT to produce clinically significant benefits (like breast screening, prostate screening).

The more I look into these things, the more appalled I am at the illness-centric, death-centric society we have become. The endless, fearful obsession so many of my fellow citizens have with cancer screening, cholesterol numbers, etc., seems so...puny. Especially since most of them cannot be bothered to do the free things which have been proven to promote health and longevity -- exercising, eating sensibly, and refraining from smoking and excessive drinking.
BobbyG: very good points. I just posted someting that addresses what you discussed:

Advocating personal responsibility in health: Bullshit!

It is actually a response to Mr. John Mackey recent editorial comment.
I always find it a bit curious when people argue that you can save lots of money by promoting healthy lifestyles. Actually, there is a Dutch study which looked into that question, and they found what I would have expected: People who live healthy lives live longer, and so actually end up costing society more than those who live fast (or fat) and die young.

Obviously, that's not an argument against lifestyle choices that can prevent obesity, cancer etc. But the point of preventive measures is to prolong life, not to save money. It doesn't really belong in the debate on cost control. If your only goal is to save money, you should stop moralising and start praising those who sacrifice themselves for the good of society by smoking and eating unhealthy food...
The "Be Healthier Don't Need Treatment" idea is a RED HERRING.

Being healthier has nothing to do with the fact that, at some point in your life, you'll need good, reasonable health care. We are human beings. We're going to get sick and die. I'm waiting for the dude who saying, "Well, we die anyway. So, if you can afford it, you get to live longer. Tough shit for all those other people."

It is not just elitist bullshit, it's a crafty way to change the subject away from the actual arguments, which are about the enormous cost of health insurance and the way in which making health care about making money has created a very very bad situation.

In a nutshell, this is what we have in this country.

1. Bootstraps!! (A bunch of people still don't realize that this is a myth.)

2. The Elect! (Yes, I know we're supposed to be past this religious bullshit, but really, that's what many Americans not so secretly think.

More money=A Better Person Closer to God Who Works Harder Than You Do--So What If You Have Three Jobs That Pay Nothing and He Has One CEO Position That He Inherited From Dad Where They Get to Play Golf All Day?

It's complete and utter crap, but there it is.
I'm surprised that though that "readers" got a chance to express their opposing viewpoints at Huffington Post. Who did they have to pay off, I wonder?answer my health question.
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